Giant colonic diverticulum: an unusual abdominal lump

Clinical features of colorectal duplication in children: A study of 25 cases

PURPOSE

To describe the clinical features and surgical management of pediatric colorectal duplication.

METHODS

Twenty-five patients with colorectal duplication at Beijing Children's Hospital between January 2010 and December 2020 were reviewed. Colorectal duplications were divided into cystic, diverticular, tubular and mixed types according to shape.

RESULTS

Of the patients, 64% were female, and 44% had accompanying malformations. Abnormal prenatal ultrasound findings (24%), abnormalities immediately found after birth (28%), and postnatal subjective symptoms (48%) were the main clinical presentations. Cystic lesions were observed in 16 patients (64%), including 12 in the colon and 4 in the rectum. Diverticular lesions were observed in 4 patients (16%), and all originated from the sigmoid colon. Among the 4 patients (16%) with tubular lesions, 3 involved the total colon, and the other originated from the splenic flexure to the proximal sigmoid colon. The patient with mixed duplication presented an intact enteric cyst within tubular duplication of the total colon. The mean age at surgery was 20 (0.3-130) months. Except for 4 total colon duplications, complete surgical resection of duplication lesions was performed in all patients. The "distal cross-section, mucosa stripping, and closure" procedure was performed in 3 patients with total colon duplication. Eighteen patients (72%) were followed up for a median time of 54.5 (5-129) months and recovered uneventfully.

CONCLUSIONS

Owing to various clinical presentations, colorectal duplication requires careful preoperative differential diagnosis. Complete surgical resection is the preferred radical method for treating cystic, diverticular and short tubular colorectal duplications, except for total colon duplications.

LEVEL OF EVIDENCE

Level IV.

Popping the Balloon: A Giant Colonic Diverticulum Complicated by Bladder Neck Compression

Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach.

Uncommon Diverticular Disease

This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.

[Laparoscopic resection of a giant colon diverticulum : Case report and review of the literature]

BACKGROUND

Giant diverticula are rare complications of diverticular disease. Current opinion regards operative therapy as the method of choice for the treatment of symptomatic giant diverticula; however, there is neither consensus about the technique nor about the necessary extent of resection. Based on a non-systematic review of the literature, an overview of giant diverticula in terms of epidemiology, pathology and classification is given. The current case is considered with respect to appropriate diagnostic procedures and possible therapeutic options.

CASE PRESENTATION

An 80-year-old female patient presented to the emergency department with abdominal pain and dyspnea. A computed tomography scan showed a large gas-filled structure in the upper left abdomen adjacent to the left colon. A giant colonic diverticulum was suspected and laparoscopy was performed. Intraoperatively, the diagnosis of a giant colon diverticulum located at the splenic flexure was confirmed. An unremarkable diverticulosis only was found in the descending colon. The giant diverticulum was treated by an atypical colon wedge resection and the postoperative course was uneventful.

DISCUSSION

This case report describes a laparoscopic atypical colon wedge resection as treatment of a giant colon diverticulum. Only four laparoscopic bowel resections in terms of sigmoid resections or hemicolectomy with primary anastomosis have been reported. Minimally invasive surgery can be a valuable alternative to open procedures. In the current case a laparoscopic atypical colon wedge resection was safely performed. This option might be considered as an alternative to extended resections of giant diverticula. Localization of the giant diverticulum and the simultaneous existence of diverticular disease are the main criteria for the decision between the different operative approaches.

A gas-filled abdominal cyst in an elderly woman: A giant colonic diverticulum case report

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Giant colonic diverticulum is a rare complication of colon diverticulosis.

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Diagnosis is based on imaging findings on plain abdominal X-ray and enhanced computered tomography.

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Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.

Introduction

Giant colonic diverticulum (GCD), a rare complication of the diverticular disease, can present with a wide range of nonspecific symptoms as abdominal pain and bowel obstruction. Its diagnosis represents a challenge that mainly depends on imaging findings.

Presentation of case

We report the case of a 79 year-old female patient that came to our emergency department complaining of 5-day history of hypogastric pain and constipation. Physical examination reveled a 15 cm hypogastric round, tender and tympanic mass. Enhanced abdominal CT scan showed a large air-filled cyst adjacent to a diverticular sigmoid colon without evidence of intra-abdominal free air or fluid. Based on the radiological features, GCD was suspected and surgical treatment performed. The mass and the sigmoid colon were resected. The postoperative course was uneventful. Histopathology confirmed the preoperative diagnosis.

Discussion

GCD, defined as a diverticulum larger than 4 cm, represents a rare complication of the diverticular disease. Usually abdominal X-ray and computed tomography (CT) scan show a gas-filled structure, sometimes communicating with the adjacent colon. GCD resection and segmental colectomy are strongly recommended even in asymptomatic cases due to the high incidence and severity of complications.

Conclusion

Because of its rarity and variable and non-specific clinical presentation, the diagnosis of GCD depends mainly on imaging findings. The gold standard treatment is surgical resection of the GCD and the compromised colon with primary anastomosis when possible.

Giant colonic diverticulum: radiographic and MDCT characteristics

Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics. Teaching points • Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.

Giant colonic diverticulum: clinical presentation, diagnosis and treatment: systematic review of 166 cases

AIM

To investigate the clinical presentation, diagnosis, and treatment of giant colonic diverticulum (GCD, by means of a complete and updated literature review). GCD is a rare manifestation of diverticular disease of the colon. Less than 200 studies on GCD were published in the literature, predominantly case reports or small patient series.

METHODS

A systematic review of the literature was performed using the Embase and PubMed databases to identify all the GCD studies. The following MESH search headings were used: "giant colonic diverticulum"; "giant sigmoid diverticulum". The "related articles" function was used to broaden the search, and all of the abstracts, studies, and citations were reviewed by two authors. The following outcomes were of interest: the disease and patient characteristics, study design, indications for surgery, type of operation, and post-operative outcomes. Additionally, a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD. A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.

RESULTS

In total, 166 GCD cases in 138 studies were identified in the literature. The most common clinical presentation was abdominal pain, which occurred in 69% of the cases. Among the physical signs, an abdominal mass was detected in 48% of the cases, whereas 20% of the patients presented with fever and 14% with abdominal tenderness. Diagnosis is based predominantly on abdominal computed tomography. The most frequent treatment was colic resection with en-bloc resection of the diverticulum, performed in 57.2% of cases, whereas Hartmann's procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%. An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null, morbidity was very low (1 patient was hospitalized in the intensive care unit for postoperative hypotension), and the patients were discharged 4-14 d after surgery.

CONCLUSION

Giant colonic diverticulum is a rare manifestation of diverticular diseases. Surgical treatment, consisting predominantly of colonic resection with en bloc resection of the diverticulum, is the preferred option for GCD and guarantees excellent results.

Giant colon diverticulum: clinical and imaging findings in 17 patients with emphasis on CT criteria

PURPOSE

The purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD).

METHODS

Medical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed.

RESULTS

CT examination revealed the GCD in all patients as a predominantly gas-filled structure communicating with the adjacent colon. Thirteen patients showed a gas-filled structure on abdominal radiograph. The mean GCD diameter was 7 cm. Most diverticula were found in the sigmoid colon. Associated diverticulosis was present in 71% of patients.

CONCLUSION

Our experience suggests that GCD can often be diagnosed on the basis of the characteristic radiographic and CT findings in these patients.

A giant gas-filled abdominal mass in an elderly female: A case report

We report an extremely rare case of gas-filled abdominal mass caused by an ovarian teratoma fistulating to the sigmoid colon. The patient was an 85-year-old female, who presented with severe abdominal distension. Urgent computed tomography scan showed a huge abdominal mass with air fluid level and fecal matter inside. Communication between the mass and the sigmoid colon was suspected. She underwent emergency laparotomy. The mass was resected with the involved segment of colon. Pathology confirmed squamous cell carcinoma arising from mature cystic teratoma of the ovary.

CT findings of misleading features of colonic diverticulitis

Colonic diverticulitis (CD) is a common entity whose diagnosis is particularly based on computed tomography (CT) examination, which is the imaging technique of choice. However, unusual CT findings of CD may lead to several difficulties and potential pitfalls: due to technical errors in the management of the CT examination, due to the anatomical situation of the diseased colon, in diagnosing unusual complications that may concern the gastrointestinal tract, intra- and retroperitoneal viscera or the abdominal wall, and in differentiating CD from other abdominal inflammatory and infectious conditions or colonic cancer. The aim of this work is to delineate the pitfalls of CT imaging and illustrate misleading CT features in patients with suspected CD.

An unusual cause of an acute abdomen--a giant colonic diverticulum

A giant colonic diverticulum (GCD) is a rare presentation of diverticular disease of the colon that usually necessitates surgery. The case described is of a GCD that became symptomatic due to rapid enlargement caused by an intracolonic bleed. GCD usually presents with abdominal pain and a palpable periumbilical or pelvic mass. Radiological imaging shows a large gas-filled cyst associated with the colon. Surgical resection with sigmoid colectomy is usually performed to alleviate symptoms and prevent later perforation.